Take a healthy interest in the medical system

Don’t sign on the bottom line and later find that there isn’t a doctor or hospital within miles if one of your family has a heart condition. If you have small children it’s also rather comforting to have medical help relatively close by. There are many English-speaking and foreign doctors in resort areas and major cities, but not necessarily so in more rural areas. Find out if there are expats living nearby and perhaps have a chat to them and find out what they think of the local medical facilities – or maybe your estate agent can help. I am going to outline very briefly a number of options on…

Don’t sign on the bottom line and later find that there isn’t a doctor or hospital within miles if one of your family has a heart condition. If you have small children it’s also rather comforting to have medical help relatively close by. There are many English-speaking and foreign doctors in resort areas and major cities, but not necessarily so in more rural areas. Find out if there are expats living nearby and perhaps have a chat to them and find out what they think of the local medical facilities – or maybe your estate agent can help.

I am going to outline very briefly a number of options on offer in the most popular
countries for emigration.

Spain
As with the UK, Spain has a national health system which provides free or low cost health care for those contributing to Spanish social security systems plus dependants. The system also caters for pensioners and this includes those from other EU countries. If, as an EU member country resident, you are visiting the country, you will be able to access emergency care on showing your EHIC (European Health Insurance Card). For details of the EHIC please see below. UK nationals over 60 and for some people who qualify for the invalidity benefit will need the appropriate form (E121 or E106) to access free health care.

The country has an excellent system of private medicine and this exists easily alongside the State system with both operated so as to compliment each other. There are many English-speaking health practitioners in Spain as this country has long been the most favoured country with British expats.

France
The healthcare system is excellent in France, one of the best in the world. If you are simply going on holiday to France, or have a home where you intend to go for short breaks, the best thing is to arm yourself with a European Health Insurance Card (EHIC) which entitles you to necessary healthcare.

Before the new rules, anyone was eligible to join the French healthcare system. Nothing has changed for those who retired in the UK, in other words you can still affiliate to the system using an E121 form via the Caisse Primaire Assurance Maladie (CPAM). You can get this form from the Dept for Work and Pensions (DWP) in Newcastle upon Tyne (take a look at www.dwp.gov.uk). As long as you are in receipt of the state pension here this form will be valid. Once you get to France you should take this form, along with proof of residence in France and a form of identity, to your local CPAM office. Most towns in France
have this office but if in doubt, ask at your local mairie. Once you are affiliated to the system you will be issued with a Carte Vitale (green card) which you have to take with you when you visit the doctor or hospital.

For those under retirement age, it is not possible to affiliate to the French system unless you have an E106 form, again available from the DWP. This is relevant for those who are not planning to work in France and is valid for up to two years, after which it is wise to take out private health insurance until you reach state retirement age or you are there for five years, after which you will be able to affiliate to the system.

If you live and work in France you will need to affiliate as a resident and in this case you should make provision to contribute financially. In most cases therefore, it is wise to take out private health insurance and even the French themselves “top up” their state benefit so that they can have full use of the system.

Unlike in the UK, in France treatment (whether private or public) is not free at the point of delivery. Even if you subscribe to the Sécurité sociale, on seeing a doctor or specialist (specialiste) you first pay the full bill (tarif) and are then reimbursed at a later date (about 10 days). Generally speaking, Sécurité sociale refunds 70 percent of the cost of a visit to a médecin traitant (a GP or family doctor) and most specialistes.

USA
Unlike other developed countries, the US does not have a universal system of healthcare coverage it is up to individuals to obtain health insurance. What that means to you as a new arrival or a part-time visitor/tourist is that it is absolutely essential to have medical insurance when in the USA.

Those who work in the States obtain coverage through their employers, and others should sign up for private insurance schemes. Under the terms of most coverage plans, members pay regular premiums, but they are sometimes also required to pay part of the cost of their treatment before the insurer will cover the expense.

American residents with a green card aged 65 or over can sign up for the government-run
Medicare scheme, and low-income parents, children, pregnant women and people with certain disabilities are eligible for the government-administered Medicaid programme. The US government also runs the State Children’s Health Insurance Program (S-Chip), which provides coverage to children whose parents are on modest incomes, but not poor enough to qualify for Medicaid. Military veterans are also provided healthcare by a government-run scheme.

Australia
In 1984 a comprehensive health care system, Medicare, was introduced in Australia. Medicare facilitates access to all eligible Australian residents for free or low-cost medical, optometric and public hospital care, while leaving them free to choose private health services should they so desire.

Individuals’ financial contributions to the public health care system are based on their
income and are made through a taxation levy known as the Medicare levy.

People admitted to public hospitals as Medicare patients receive treatment by doctors
and specialists nominated by the hospital. They are not charged for care and treatment or after-care by the treating doctor. Private paying patients in public or private hospitals on the other hand can choose the doctor who treats them.

Medicare pays 75 percent of the Medicare schedule fee for services and procedures
provided by the treating doctor. For patients who have private health insurance, some or all of the outstanding balance may be covered. Medicare Australia also pays pharmaceutical benefits under the Pharmaceutical Benefits Scheme, which subsidises an agreed list of prescription drugs. For both medical and pharmaceutical services, safety net arrangements exist to make sure patients who need a high level of treatment or medication during a financial year do not incur significant out-of-pocket expenses. Out-of-pocket costs are the difference between the Medicare benefit and what the patient is actually charged.

The Australian Government has signed reciprocal health care agreements with the
governments of the UK, the Republic of Ireland, Finland, Italy, Malta, the Netherlands, Norway, New Zealand and Sweden. Visitors from these countries are eligible for Medicare assistance for medically necessary treatment only. If hospital treatment is required, such visitors are eligible for treatment only as Medicare patients and not as private patients.
Other visitors are not eligible for Medicare and should arrange for health insurance to cover their stay in Australia

Greece has a national health care system that provides free or low cost health care to residents and, as a EU member country resident, you will be treated on the same basis as a resident of Greece. Non-EU citizens should arrange private health insurance before they leave their home country; however, emergencycare is provided free of charge in public hospitals to anyone, regardless of nationality. You should obtain a European Health Insurance Card (EHIC) before leaving the UK – you have to present this to get free medical treatment
– see more about the EHIC below.

South Africa
South Africa’s health system consists of a large under-resourced and over-used public
sector, under pressure to deliver services to about 80 percent of the population and a
smaller but fast-growing private sector. This private sector is run largely on commercial lines and caters to middle and high-income earners who tend to be members of medical schemes (18 percent of the population), and to foreigners looking for top-quality surgical procedures at relatively affordable prices.

It is virtually mandatory to have a private medical aid either through your employer,
who shares the cost with you, or individually. State hospitals are appalling – take it from one who knows. As a tourist, visitor or émigré, you would be well advised to get medical insurance cover.

New Zealand
Under the public healthcare scheme in New Zealand, a certain degree of care is offered free to its residents and to those with work permits that allow them to temporarily reside in New Zealand.
The hospitals are publicly run and treat citizens or permanent residents free
of charge. Waiting times for non-urgent care can be fairly long and many
patients are going private in order to be treated faster.

The current system, funded by taxes, includes free prescriptions and treatments at
public hospitals, free x-rays and laboratory tests when carried out from public
hospitals or clinics, free service charges for pregnant women, free dental care
for children at school age, and free breast screenings for women aging fifty
above.

The other free services offered are subsidised GP referral visits, free treatments
for patients suffering with chronic conditions and subsidised prescriptions for
children six years old and younger.

To benefit from the public health system in New Zealand, you must hold a permanent
resident visa, be a resident of the country or hold a work permit for two years at the time of application. To check your eligibility, please take the test at http://www.moh.govt.nz/. If you meet the criteria, your partner and children aged 19 years or under will also be
eligible for publicly funded healthcare. If you do not meet these requirements, you have to take out a private health insurance in New Zealand or before departure from your country of origin, either if you plan to stay or if you are just visiting.

The EHIC or European Health Insurance Card
In 2006 the E111 form was phased out and replaced by the free European Health
Insurance Card (EHIC). Also called the EU Medical Card, it looks just like a small plastic ID card and gives details such as your name, date of birth and National Insurance number.

The card lasts for 3-5 years and entitles you to receive free or reduced-cost emergency healthcare if you or any of your dependants are suddenly taken ill or have an accident when visiting countries with reciprocal health agreements with the UK (European Union countries plus Iceland, Liechtenstein, Norway and Switzerland).

You should obtain a European Health Insurance Card (EHIC) before leaving the UK – you have to present this to get free or rebated medical expenses as mentioned above. The EHIC is available free of charge through most UK post offices or apply online at www.ehic.org.uk You can also contact them on 0845 606 2030 and get them to send you one. Expect to wait 7 days for an online application, 10 days if you phone in and 21 days through the Post Office. Every family member (individual traveller) needs their own card – that includes children – and you will need the name, date of birth and NHS or national insurance (NI) number of everyone you are applying for. Just a note here: I took this information off the EHIC website: when I went to my Post Office they no longer offer this facility and when I applied online I had to pay a fee of £9.95.

Remember, your EHIC is not a substitute for travel insurance. It won’t cover you for repatriation (return home) or losses due to crime or natural disasters. Only comprehensive travel health insurance cover, which you’ll have to take out privately, would cover you for that.

Only state-provided treatment is covered, and you’ll receive treatment on the same terms as ‘insured’ residents of the country you’re visiting. Private treatment isn’t covered, and state-provided treatment may not cover all of the things that you’d expect to receive free of charge from the NHS.

Kim Brown is the author of the Emigration Guide. To get your copy go to: www.emigrationguide.com

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